MEDICARE: METROPOLITAN ORAL SURGERY ASSOCIATES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)

General Provider Information

NPI Number	:	1861594863
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	METROPOLITAN ORAL SURGERY ASSOCIATES LLC

Provider Business Mailing Address
First Line	:	1175 PEACHTREE ST NE
Second Line	:	SUITE 1202
City	:	ATLANTA
State	:	GA
Zip	:	30361-6202
Country	:	US
Telephone Number	:	404-874-1115
Fax Number	:	404-874-0624

Provider Business Practice Location Address
First Line	:	1175 PEACHTREE ST NE
Second Line	:	SUITE 1202
City	:	ATLANTA
State	:	GA
Zip	:	30361-6202
Country	:	US
Telephone Number	:	404-874-1115
Fax Number	:	404-874-0624

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JOYCE T. LEE
Credential	:	DDS, MD
Telephone Number	:	404-874-1115

Provider Enumeration Date	:	09/01/2006
Last Update Date	:	08/22/2020

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